Persistent psychotic symptoms following COVID-19 infection.

To date, there have been no detailed reports of patients developing persistent psychotic symptoms following Coronavirus disease 2019 (COVID-19) infection. There have been reports of patients developing transient delirium (with and without hypoxia) after COVID-19 infection as well as other neurological manifestations. We report on a female patient who, post-COVID-19 infection, developed an initial delirium followed by persistent and florid psychotic symptoms consisting of persecutory delusion, complex visual and auditory hallucinations and Capgras phenomenon in the absence of hypoxia but elevated tumour necrosis factor (TNF)-α.

Quality improvement- where do we stand?

Improvements in quality are commonly used to measure outcome in modern medicine. The drive to improve services nationally and to reduce the financial burden, which is at the forefront of NHS policy, attracts political debate and is constantly the focus of media attention. However, before this can be done in surgery, we need to learn from ongoing work and recognised systems for quality review and implementation, and develop national processes for sustained improvement.

Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds.

Introduction: Magnetic resonance imaging (MRI) cerebral microbleeds (CMB) arise from ferromagnetic haemosiderin iron assumed to derive from extravasation of erythrocytes. Light microscopy of ageing brain frequently reveals foci of haemosiderin from single crystalloids to larger, predominantly perivascular, aggregates. The pathological and radiological relationship between these findings is not resolved.